Method for treating drug-induced constipation

ABSTRACT

Provided is a method for treating drug-induced constipation comprising a step of administering an effective amount of a 15-keto-prostaglaindin compound to a subject suffering from drug-induced constipation or a subject having a strong possibility of suffering from it. According to the present invention, a strong antagonistic action against drug-induced constipation can be obtained without substantially losing the main effect of the drug.

TECHNICAL FIELD

[0001] The present invention relates to a novel use of a15-keto-prostaglandin compound for treating drug-induced constipation.

RELATED ART

[0002] Constipation is classified into functional constipation such asan atonic constipation, spastic constipation, rectal constipation,organic constipation such as caused by bowel disease and by stenosis dueto postoperative adhesion, drug-induced constipation and the like.

[0003] Drug-induced constipation occurs as a side effect caused by usinga drug. The drug may cause constipation not directly but indirectly. Forexample, constipation may be due to hard feces caused by fluid excretionoutside the body with a diuretic. Further, it may be caused by anadditive or synergistic effect of using plural drugs, each of which doesnot introduce constipation if administrated individually.

[0004] It is known that drugs causing constipation include narcoticsused for controlling cancer pain (opioid-narcotic such as morphine andcodeine), anticholinergic (such as antiparkinsonism drug, tricyclic andtetracyclic antidepressant and antiincontinence drug), antacid (such asaluminium preparation), bone weight increasing agent (such as calciumpreparation), diuretic, iron preparation, calcium antagonist,benzodiazepine compound, phenotiazine compound (such as chlorpromazine),H₂-blocker, pill, tocopherol and the like.

[0005] For example, opioid such as morphine, which is one kind ofnarcotics, has a depressant action on the central nervous system (suchas analgesic, antitussive, sedative or hypnotic action) and, since itsanalgesic action is extremely strong, it is effective for almost allpains including surgical and cancer pains. On the other hand, itexhibits a constipating action by affecting gastrointestine as aperipheral effect. Accordingly, when morphine is used for treating pain,almost all the patients applied with morphine constipate, and failure tocontrol it will cause intractable constipation. Constipation is causedby administering the dose of morphine necessary for effecting analgesicaction and it is hard to become tolerant, so that constipation continuesas long as the administration of morphine by any route continues. Forexample, if morphine is applied to a cancer patient for relieving painwithout taking sufficient steps for controlling constipation, it willbecome unable to continue the administration of morphine, thus degradingthe therapeutic result of cancer pain relief. For this reason, duringrepetitious administration of morphine, it is very important to controlconstipation.

[0006] However, it has been reported that constipation induced by opioidsuch as morphine is not often sufficiently controlled by conventionalcathartics (Twycross, R. G. et al.: Constipation. In: Control ofalimentary symptoms in far advanced cancer. Edinburgh: ChurchillLivingstone, 1986: 172-177, the cited references are herein incorporatedby reference).

[0007] Recently, opioid antagonist such as naloxone has been tried torelax opioid-induced constipation at the sacrifice of analgesic actionof opioid. It has been reported that use of opioid antagonist againstopioid-induced constipation causes side effects such as return of painand opioid withdrawal, which is contradict to the original purpose ofthe opioid administration (Culpepper-Morgan, J. A. et al.: NIDA Res.Monoger. 95: 399-400, 1989. and Clin. Pharmacol. Ther. 52: 90-95, 1992:Sykes, N. P.: Palliat-Med.10:135-144, 1996, the cited references areherein incorporated by reference).

[0008] Accordingly, it has been desired to develop a drug for relaxingdrug-induced constipation without losing the main effect, for example,analgesic action of opioid such as morphine, of the drug.

[0009] Prostaglandins (hereinafter, referred to as PG(s)) are members ofclass of organic carboxylic acids, which are contained in tissues ororgans of human or other mammals, and exhibit a wide range ofphysiological activity. PGs found in nature (primary PGs) generally havea prostanoic acid skeleton as shown in the formula (A):

[0010] On the other hand, some of synthetic analogues of primary PGshave modified skeletons. The primary PGs are classified to PGAs, PGBs,PGCs, PGDs, PGEs, PGFs, PGGs, PGHs, PGIs and PGJs according to thestructure of the five-membered ring moiety, and further classified intothe following three types by the number and position of the unsaturatedbond at the carbon chain moiety:

[0011] Subscript 1: 13,14-unsaturated-15-OH

[0012] Subscript 2: 5,6- and 13,14-diunsaturated-15-OH

[0013] Subscript 3: 5,6-, 13,14-, and 17,18-triunsaturated-15-OH.

[0014] Further, the PGFs are classified, according to the configurationof the hydroxyl group at the 9-position, into α type (the hydroxyl groupis of an α-configuration) and β type (the hydroxyl group is of aβ-configuration).

[0015] PGE₁ and PGE₂ and PGE₃ are known to have vasodilatation,hypotension, gastric secretion decreasing, intestinal tract movementenhancement, uterine contraction, diuretic, bronchodilation and antiulcer activities. PGF_(1α), PGF_(2α) and PGF_(3α) have been known tohave hypertension, vasoconstriction, intestinal tract movementenhancement, uterine contraction, lutein body atrophy andbronchoconstriction activities.

[0016] In addition, some 15-keto PGs (i.e. those having an oxo group atposition 15 in place of the hydroxy group) and 13,14-dihydro-15-keto-PGsare known as substances naturally produced by enzymatic reactions duringin vivo metabolism of primary PGs. 15-keto PG compound have beendisclosed in the specification of U.S. Pat. Nos. 5,073,569, 5,166,174,5,221,763, 5,212,324 and 5,739,161 (These cited references are hereinincorporated by reference).

[0017] The so-called primary PGs having hydroxy at the 15-position suchas PGE₁, PGE₂ and the derivatives or analogs thereof are known toantagonize the enterogastric action of morphine (Christmas A. J.:Prostaglandins 18, 279-284, 1979; B. J. Broughton: Prostaglaindins 22,53-64, 1981, the cited references are herein incorporated by reference).

[0018] However, PGE₁ and PGE₂ are well known pain enhancing substances,which augment the action of bradykinin, a strong pain producingsubstance, and other pain producing substances. Accordingly, theso-called primary PGs having hydroxy at the 15-position have apossibility of affecting the analgesic action of opioid.

[0019] On the other hand, a 15-keto-16-halogen-PG compound is known tobe useful as a cathartic (U.S. Pat. No. 5,317,032). However, it is notknown at all how the 15-keto-PG compound affects the opioid-inducedconstipation or how it affects the main effect of a drug, e.g., theanalgesic action of opioid.

SUMMARY OF THE INVENTION

[0020] The purpose of the present invention is to provide a compositionfor treating drug-induced constipation, which has a strong antagonisticaction against drug-induced constipation without substantially losingthe main effect of the drug.

[0021] As a result of a diligent research for biological activity of15-keto-prostaglaindin compounds, the present inventor has found that a15-keto-prostaglaindin compound has a superior antagonistic actionagainst drug-induced constipation. Especially, because of its superiorantagonistic action against opioid-induced constipation withoutaffecting the analgesic action of opioid such as morphine on centralnervous system, the compound has been found to be very useful forcontrolling opioid-induced constipation. Thus, the present invention hasbeen completed.

[0022] Namely, the present invention relates to a composition fortreating drug-induced constipation comprising a 15-keto-prostaglandincompound as an active ingredient.

[0023] The present invention also relates to a method for treatingdrug-induced constipation comprising a step of administering aneffective amount of 15-keto-prostaglaindin compound to a subjectsuffering from drug-induced constipation or a subject having a strongpossibility of suffering from it.

[0024] The present invention further relates to use of a15-keto-prostaglaindin compound for manufacturing a pharmaceuticalcomposition for treating drug-induced constipation.

DETAILED DESCRIPTION OF THE INVENTION

[0025] In the present invention, the “15-keto-prostaglandin compound”(hereinafter, referred to as “15-keto-PG compound”) may include any ofderivatives or analogs (including substituted derivatives) of a compoundhaving an oxo group at 15-position of the prostanoic acid skeletoninstead of the hydroxy group, irrespective of the configuration of thefive-membered ring, the number of double bonds, presence or absence of asubstituent, or any other modification in the α or ω chain.

[0026] The nomenclature of the 15-keto-PG compounds used herein is basedon the numbering system of the prostanoic acid represented in the aboveformula (A).

[0027] The formula (A) shows a basic skeleton of the C-20 carbon atoms,but the 15-keto-PG compounds in the present invention are not limited tothose having the same number of carbon atoms. In the formula (A), thenumbering of the carbon atoms which constitute the basic skeleton of thePG compounds starts at the carboxylic acid (numbered 1), and carbonatoms in the α-chain are numbered 2 to 7 towards the five-membered ring,those in the ring are 8 to 12, and those in the ω-chain are 13 to 20.When the number of carbon atoms is decreased in the α-chain, the numberis deleted in the order starting from position 2; and when the number ofcarbon atoms is increased in the α-chain, compounds are named assubstitution compounds having respective substituents at position 2 inplace of the carboxy group (C-1). Similarly, when the number of carbonatoms is decreased in the ω-chain, the number is deleted in the orderstarting from position 20; and when the number of carbon atoms isincreased in the ω-chain, the carbon atoms beyond position 20 are namedas substituents. Stereochemistry of the compounds is the same as that ofthe above formula (A) unless otherwise specified.

[0028] In general, each of the terms PGD, PGE and PGF represents a PGcompound having hydroxy groups at positions 9 and/or 11, but in thepresent specification, these terms also include those havingsubstituents other than the hydroxy group at positions 9 and/or 11. Suchcompounds are referred to as 9-dehydroxy-9-substituted-PG compounds or11-dehydroxy-11-substituted-PG compounds. A PG compound having hydrogenin place of the hydroxy group is simply named as 9- or 11-dehydroxycompound.

[0029] As stated above, the nomenclature of the 15-keto-PG compounds isbased on the prostanoic acid skeleton. However, in case the compound hasa similar partial construction as a prostaglandin, the abbreviation of“PG” may be used. Thus, a PG compound of which α-chain is extended bytwo carbon atoms, that is, having 9 carbon atoms in the α-chain is namedas 2-decarboxy-2-(2-carboxyethyl)-15-keto-PG compound. Similarly, a PGcompound having 11 carbon atoms in the α-chain is named as2-decarboxy-2-(4-carboxybutyl)-15-keto-PG compound. Further, a PGcompound of which ω-chain is extended by two carbon atoms, that is,having 10 carbon atoms in the ω-chain is named as 15-keto-20-ethyl-PGcompound. These compounds, however, may also be named according to theIUPAC nomenclatures.

[0030] The 15-keto-PGs used in the present invention may include any PGderivatives or analogs insofar as having an oxo group at position 15 inplace of the hydroxy group. Accordingly, for example, a 15-keto-PG type1 compound having a double bond at 13-14 position, a 15-keto-PG type 2compound having two double bond at 13-14 and 5-6 position, a 15-keto-PGtype 3 compound having three double bond at 5-6, 13-14 and 17-18position, 13,14-dihydro-15-keto-PG compound wherein the double bond at13-14 position is single bond.

[0031] Typical examples of the compounds used in the present inventioninclude 15-keto-PG type 1, 15-keto-PG type 2, 15-keto-PG type 3,13,14-dihydro-15-keto-PG type 1, 13,14-dihydro-15-keto-PG type 2,13,14-dihydro-15-keto-PG type 3 and the derivatives or analogs thereof.

[0032] Examples of the analogs (including substituted derivatives) orderivatives include a 15-keto-PG compound of which carboxy group at theend of α-chain is esterified; a compound of which α-chain is extended;physiologically acceptable salt thereof; a compound having a double bondat 2-3 position or a triple bond at position 5-6, a compound havingsubstituent(s) at position 3, 5, 6, 16, 17, 18, 19 and/or 20; and acompound having lower alkyl or a hydroxy (lower) alkyl group at position9 and/or 11 in place of the hydroxy group.

[0033] According to the present invention, preferred substituents atposition 3, 17, 18 and/or 19 include alkyl having 1-4 carbon atoms,especially methyl and ethyl. Preferred substituents at position 16include lower alkyl such as methyl and ethyl, hydroxy, halogen atomssuch as chlorine and fluorine, and aryloxy such astrifluoromethylphenoxy. Preferred substituents at position 17 includelower alkyl such as methyl and ethyl, hydroxy, halogen atoms such aschlorine and fluorine, aryloxy such as trifluoromethylphenoxy. Preferredsubstituents at position 20 include saturated or unsaturated lower alkylsuch as C1-4 alkyl, lower alkoxy such as C1-4 alkoxy, and lower alkoxyalkyl such as C1-4 alkoxy-C1-4 alkyl. Preferred substituents at position5 include halogen atoms such as chlorine and fluorine. Preferredsubstituents at position 6 include an oxo group forming a carbonylgroup. Stereochemistry of PGs having hydroxy, lower alkyl orhydroxy(lower)alkyl substituent at position 9 and/or 11 may be α, β or amixture thereof.

[0034] Further, the above analogs or derivatives may be compounds havingan alkoxy, cycloalkyl, cycloalkyloxy, phenoxy or phenyl group at the endof the ω-chain where the chain is shorter than the primary PGs.

[0035] Especially preferred compounds include a 13,14-dihydro-15-keto-PGcompound which has a single bond at position 13-14; a 15-keto-16 mono ordi-halogen PG compound which has one or two halogen atoms such aschlorine and fluorine at position 16; and a 15-keto-PGE compound whichhas an oxo group at position 9 and a hydroxyl group at position 11 ofthe five membered ring.

[0036] A preferred compound used in the present invention is representedby the formula (I):

[0037] wherein

[0038] L, M and N are hydrogen, hydroxy, halogen, lower alkyl,hydroxy(lower)alkyl, or oxo, wherein at least one of L and M is a groupother than hydrogen, and the five-membered ring may have at least onedouble bond;

[0039] A is —CH₂OH, —COCH₂OH, —COOH or a functional derivative thereof;

[0040] B is —CH₂—CH₂—, —CH═CH— or —C≡C—;

[0041] R₁ is a saturated or unsaturated bivalent lower or mediumaliphatic hydrocarbon residue, which is unsubstituted or substitutedwith halogen, alkyl, hydroxy, oxo, aryl or heterocyclic group and atleast one of carbon atom in the aliphatic hydrocarbon is optionallysubstituted by oxygen, nitrogen or sulfur; and

[0042] Ra is a saturated or unsaturated lower or medium aliphatichydrocarbon residue, which is unsubstituted or substituted with halogen,oxo, hydroxy, lower alkoxy, lower alkanoyloxy, cyclo(lower)alkyl,cyclo(lower)alkyloxy, aryl, aryloxy, heterocyclic group orhetrocyclic-oxy group; cyclo(lower)alkyl; cyclo(lower)alkyloxy; aryl;aryloxy; heterocyclic group; heterocyclic-oxy group.

[0043] A group of particularly preferable compounds among theabove-described compounds is represented by the formula (II):

[0044] wherein L and M are hydrogen, hydroxy, halogen, lower alkyl,hydroxy(lower)alkyl or oxo, wherein at least one of L and M is a groupother than hydrogen, and the five-membered ring may have at least onedouble bond;

[0045] A is —CH₂OH, —COCH₂OH, —COOH or a functional derivative thereof;

[0046] B is —CH₂—CH₂—, —CH═CH—, —C≡C—;

[0047] X₁ and X₂ are hydrogen, lower alkyl, or halogen;

[0048] R₁ is a saturated or unsaturated bivalent lower or mediumaliphatic hydrocarbon residue, which is unsubstituted or substitutedwith halogen, alkyl, hydroxy, oxo, aryl or heterocyclic group and atleast one of carbon atom in the aliphatic hydrocarbon is optionallysubstituted by oxygen, nitrogen or sulfur;

[0049] R₂ is a single bond or lower alkylene; and

[0050] R₃ is lower alkyl, lower alkoxy, cyclo(lower)alkyl,cyclo(lower)alkyloxy, aryl, aryloxy, heterocyclic group orheterocyclic-oxy group.

[0051] In the above formula, the term “unsaturated” in the definitionsfor R₁ and Ra is intended to include at least one or more double bondsand/or triple bonds that are isolatedly, separately or serially presentbetween carbon atoms of the main and/or side chains. According to theusual nomenclature, an unsaturated bond between two serial positions isrepresented by denoting the lower number of the two positions, and anunsaturated bond between two distal positions is represented by denotingboth of the positions.

[0052] The term “lower or medium aliphatic hydrocarbon” refers to astraight or branched chain hydrocarbon group having 1 to 14 carbon atoms(for a side chain, 1 to 3 carbon atoms are preferable) and preferably 1to 10, especially 6 to 10 carbon atoms for R₁ and 1 to 10, especially 1to 8 carbon atoms for R_(a).

[0053] The term “halogen” covers fluorine, chlorine, bromine and iodine.

[0054] The term “lower” throughout the specification is intended toinclude a group having 1 to 6 carbon atoms unless otherwise specified.

[0055] The term “lower alkyl” refers to a straight or branched chainsaturated hydrocarbon group containing 1 to 6 carbon atoms and includes,for example, methyl, ethyl, propyl, isopropyl, butyl, isobutyl, t-butyl,pentyl and hexyl.

[0056] The term “lower alkylene” refers to a straight or branched chainbivalent saturated hydrocarbon group containing 1 to 6 carbon atoms andincludes, for example, methylene, ethylene, propylene, isopropylene,butylene, isobutylene, t-butylene, pentylene and hexylene.

[0057] The term “lower alkoxy” refers to a group of lower alkyl-O-,wherein lower alkyl is as defined above.

[0058] The term “hydroxy(lower)alkyl” refers to a lower alkyl as definedabove which is substituted with at least one hydroxy group such ashydroxymethyl, 1-hydroxyethyl, 2-hydroxyethyl and1-methyl-l-hydroxyethyl.

[0059] The term “lower alkanoyloxy” refers to a group represented by theformula RCO—O—, wherein RCO— is an acyl group formed by oxidation of alower alkyl group as defined above, such as acetyl.

[0060] The term “cyclo(lower)alkyl” refers to a cyclic group formed bycyclization of a lower alkyl group as defined above but contains threeor more carbon atoms, and includes, for example, cyclopropyl,cyclobutyl, cyclopentyl and cyclohexyl.

[0061] The term “cyclo(lower)alkyloxy” refers to the group ofcyclo(lower)alkyl-O-, wherein cyclo(lower)alkyl is as defined above.

[0062] The term “aryl” may include unsubstituted or substituted aromatichydrocarbon rings (preferably monocyclic groups), for example, phenyl,tolyl, and xylyl. Examples of the substituents are halogen atom andhalo(lower)alkyl, wherein halogen atom and lower alkyl are as definedabove.

[0063] The term “aryloxy” refers to a group represented by the formulaArO—, wherein Ar is aryl as defined above.

[0064] The term “heterocyclic group” may include mono- to tri-cyclic,preferably monocyclic heterocyclic group which is 5 to 14, preferably 5to 10 membered ring having optionally substituted carbon atom and 1 to4, preferably 1 to 3 of 1 or 2 types of hetero atoms selected fromnitrogen atom, oxygen atom and sulfur atom. Examples of the heterocyclicgroup include furyl, thienyl, pyrrolyl, oxazolyl, isoxazolyl, thiazolyl,isothiazolyl, imidazolyl, pyrazolyl, furazanyl, pyranyl, pyridyl,pyridazinyl, pyrimidyl, pyrazinyl, 2-pyrrolinyl, pyrrolidinyl,2-imidazolinyl, imidazolidinyl, 2-pyrazolinyl, pyrazolidinyl,piperidino, piperazinyl, morpholino, indolyl, benzothienyl, quinolyl,isoquinolyl, purinyl, quinazolinyl, carbazolyl, acridinyl,phenanthridinyl, benzimidazolyl, benzimidazolonyl, benzothiazolyl,phenothiazinyl. Examples of the substituent in this case includehalogen, and halogen substituted lower alkyl group, wherein halogen atomand lower alkyl group are as described above.

[0065] The term “heterocyclic-oxy group” means a group represented bythe formula HcO—, wherein Hc is a heterocyclic group as described above.

[0066] The term “functional derivative” of A includes salts (preferablypharmaceutically acceptable salts), ethers, esters and amides.

[0067] Suitable “pharmaceutically acceptable salts” includeconventionally used non-toxic salts, for example a salt with aninorganic base such as an alkali metal salt (such as sodium salt andpotassium salt), an alkaline earth metal salt (such as calcium salt andmagnesium salt), an ammonium salt; or a salt with an organic base, forexample, an amine salt (such as methylamine salt, dimethylamine salt,cyclohexylamine salt, benzylamine salt, piperidine salt, ethylenediaminesalt, ethanolamine salt, diethanolamine salt, triethanolamine salt,tris(hydroxymethylamino) ethane salt, monomethyl-monoethanolamine salt,procaine salt and caffeine salt), a basic amino acid salt (such asarginine salt and lysine salt), tetraalkyl ammonium salt and the like.These salts may be prepared by a conventional process, for example fromthe corresponding acid and base, or by salt interchange.

[0068] Examples of the ethers include alkyl ethers, for example, loweralkyl ethers such as methyl ether, ethyl ether, propyl ether, isopropylether, butyl ether, isobutyl ether, t-butyl ether, pentyl ether and1-cyclopropyl ethyl ether; and medium or higher alkyl ethers such asoctyl ether, diethylhexyl ether, lauryl ether and cetyl ether;unsaturated ethers such as oleyl ether and linolenyl ether; loweralkenyl ethers such as vinyl ether, allyl ether; lower alkynyl etherssuch as ethynyl ether and propynyl ether; hydroxy(lower)alkyl etherssuch as hydroxyethyl ether and hydroxyisopropyl ether; lower alkoxy(lower)alkyl ethers such as methoxymethyl ether and 1-methoxyethylether; optionally substituted aryl ethers such as phenyl ether, tosylether, t-butylphenyl ether, salicyl ether, 3,4-di-methoxyphenyl etherand benzamidophenyl ether; and aryl(lower)alkyl ethers such as benzylether, trityl ether and benzhydryl ether.

[0069] Examples of the esters include aliphatic esters, for example,lower alkyl esters such as methyl ester, ethyl ester, propyl ester,isopropyl ester, butyl ester, isobutyl ester, t-butyl ester, pentylester and 1-cyclopropylethyl ester; lower alkenyl esters such as vinylester and allyl ester; lower alkynyl esters such as ethynyl ester andpropynyl ester; hydroxy(lower)alkyl ester such as hydroxyethyl ester;lower alkoxy (lower) alkyl esters such as methoxymethyl ester and1-methoxyethyl ester; and optionally substituted aryl esters such as,for example, phenyl ester, tolyl ester, t-butylphenyl ester, salicylester, 3,4-di-methoxyphenyl ester and benzamidophenyl ester; andaryl(lower)alkyl ester such as benzyl ester, trityl ester and benzhydrylester.

[0070] The amide of A means a group represented by the formula —CONR′R″,wherein each of R′ and R″ is hydrogen, lower alkyl, aryl, alkyl- oraryl-sulfonyl, lower alkenyl and lower alkynyl, and include for examplelower alkyl amides such as methylamide, ethylamide, dimethylamide anddiethylamide; arylamides such as anilide and toluidide; and alkyl- oraryl-sulfonylamides such as methylsulfonylamide, ethylsulfonyl-amide andtolylsulfonylamide.

[0071] Preferred examples of L and M include hydroxy and oxo, andespecially, M is hydroxy and L is oxo which has a 5-membered ringstructure of, so called, PGE type.

[0072] Preferred example of A is —COOH, its pharmaceutically acceptablesalt, ester or amide thereof.

[0073] Preferred example of B is —CH₂—CH₂—, which provide the structureof so-called, 13,14-dihydro type.

[0074] Preferred example of X₁ and X₂ is that at least one of them ishalogen, more preferably, both of them are halogen, especially, fluorinethat provides a structure of, so called 16,16-difluoro type.

[0075] Preferred R₁ is a hydrocarbon containing 1-10 carbon atoms,preferably, 6-10 carbon atoms. Further, at least one of carbon atom inthe aliphatic hydrocarbon is optionally substituted by oxygen, nitrogenor sulfur.

[0076] Examples of R₁ include, for example, the following groups:

[0077] —CH₂—CH₂—CH₂—CH₂—CH₂—CH₂—,

[0078] —CH₂—CH═CH—CH₂—CH₂—CH₂—,

[0079] —CH₂—CH₂—CH₂—CH₂—CH═CH—,

[0080] —CH₂—C≡C—CH₂—CH₂—CH₂—,

[0081] —CH₂—CH₂—CH₂—CH₂—CH(CH₃)—CH₂—

[0082] —CH₂—CH₂—CH₂—CH₂—O—CH₂—,

[0083] —CH₂—CH═CH—CH₂—O—CH₂—,

[0084] —CH₂—C≡C—CH₂—O—CH₂—,

[0085] —CH₂—CH₂—CH₂—CH₂—CH₂—CH₂—CH₂—,

[0086] —CH₂—CH═CH—CH₂—CH₂—CH₂—CH₂—,

[0087] —CH₂—CH₂—CH₂—CH₂—CH₂—CH═CH—,

[0088] —CH₂—C≡C—CH₂—CH₂—CH₂—CH₂—,

[0089] —CH₂—CH₂—CH₂—CH₂—CH₂—CH(CH₃)—CH₂—,

[0090] —CH₂—CH₂—CH₂—CH₂—CH₂—CH₂—CH₂—CH₂—,

[0091] —CH₂—CH═CH—CH₂—CH₂—CH₂—CH₂—CH₂—,

[0092] —CH₂—CH₂—CH₂—CH₂—CH₂—CH₂—CH═CH—,

[0093] —CH₂—C≡C—CH₂—CH₂—CH₂—CH₂—CH₂—,

[0094] —CH₂—CH₂—CH₂—CH₂—CH₂—CH₂—CH(CH₃)—CH₂—

[0095] Preferred Ra is a hydrocarbon containing 1-10 carbon atoms, morepreferably, 1-8 carbon atoms. Ra may have one or two side chains havingone carbon atom.

[0096] The configuration of the ring and the α- and/or ω chains in theabove formula (I) and (II) may be the same as or different from that ofthe primary PGs. However, the present invention also includes a mixtureof a compound having a primary type configuration and a compound of anon-primary type configuration.

[0097] The Examples of the typical compound in the invention are13,14-dihydro-15-keto-16-mono or difluoro-PGE compound, the derivativesor analogs thereof.

[0098] The 15-keto-PG compound of the present invention may be in theketo-hemiacetal equilibrium by formation of a hemiacetal between hydroxyat position 11 and oxo at position 15.

[0099] For example, it has been revealed that when both of X₁ and X₂ arehalogen atoms, especially, fluorine atoms, the compound contains atautomeric isomer, bicyclic compound.

[0100] If such tautomeric isomers as above are present, the proportionof both tautomeric isomers varies with the structure of the rest of themolecule or the kind of the substituent present. Sometimes one isomermay predominantly be present in comparison with the other. However, itis to be appreciated that the 15-keto-PG compounds used in the inventioninclude both isomers.

[0101] Further, the 15-keto-PG compounds used in the invention includethe bicyclic compound and analogs or derivatives thereof. The bicycliccompounds is represented by the formula (III)

[0102] whererin, A is —CH₂OH, —COCH₂OH, —COOH or a functional derivativethereof;

[0103] X₁′ and X₂″ are hydrogen, lower alkyl, or halogen;

[0104] Y is

[0105] R₄′ and R₅″ are hydrogen, hydroxy, halogen, lower alkyl, loweralkoxy or hydroxy(lower)alkyl, wherein R₄′ and R₅′ are not hydroxy andlower alkoxy at the same time.

[0106] R₁ is a divalent saturated or unsaturated lower or mediumaliphatic hydrocarbon residue, which is unsubstituted or substitutedwith halogen, alkyl, hydroxy, oxo, aryl or heterocyclic group and atleast one of carbon atom in the aliphatic hydrocarbon is optionallysubstituted by oxygen, nitrogen or sulfur; and

[0107] Ra′ is a saturated or unsaturated lower or medium aliphatichydrocarbon residue, which is unsubstituted or substituted with halogen,oxo, hydroxy, lower alkoxy, lower alkanoyloxy, cyclo(lower)alkyl,cyclo(lower)alkyloxy, aryl, aryloxy, heterocyclic group orhetrocyclic-oxy group; cyclo(lower)alkyl; cyclo(lower)alkyloxy; aryl;aryloxy; heterocyclic group; heterocyclic-oxy group.

[0108] R₃′ is hydrogen, lower alkyl, cyclo(lower)alkyl, aryl orheterocyclic group.

[0109] Further more, while the compounds used in the invention may berepresented by a structure formula or name based on keto-type regardlessof the presence or absence of the isomers, it is to be noted that suchstructure or name does not intend to exlclude the hemiacetal typecompound.

[0110] In the present invention, any of isomers such as the individualtautomeric isomers, the mixture thereof, or optical isomers, the mixturethereof, a racemic mixture, and other steric isomers may be used in thesame purpose.

[0111] Some of the compounds used in the present invention may beprepared by the method disclosed in U.S. Pat. Nos. 5,073,569, 5,166,174,5,221,763, 5,212,324 and 5,739,161 and 6,242,485.

[0112] (these cited references are herein incorporated by reference)

[0113] The subject to be treated by the present invention may be anymammalian subject including animals and human beings. According to themethod of the present invention, a pharmaceutical composition comprisinga 15-keto-prostaglandin composition as an active ingredient may beadministrated either systemically or topically.

[0114] Usually, the composition is administered by oral administration,intravenous injection (including infusion), subcutaneous injection,intra rectal administration, intra vaginal administration and the like.The dose of the active ingredient may vary depending on the strain i.e.particular animal or human, age, sex, body weight of the patient to betreated, symptom to be treated, desired therapeutic effect,administration route, term of treatment and the like.

[0115] Typically, a satisfactory effect can be obtained by systemicadministration 1-4 times per day or continuous administration of the15-keto-prostaglandin compound at the amount of 0.00001-100 mg/kg perday.

[0116] The composition of the present invention can be formulated as acomposition for oral administration, for injection, for perfusion or forexternal administration, tablet, sublingual, suppository, and vaginalsuppository.

[0117] The composition of the present invention may further containphysiologically acceptable additives. Said additives may include theingredients used with the 15-keto-PG compound such as excipient,diluent, filler, resolvent, lubricant, adjuvant, binder, disintegrator,coating agent, cupsulating agent, ointment base, suppository base,aerozoling agent, emulsifier, dispersing agent, suspending agent,thickener, tonicity agent, buffering agent, soothing agent,preservative, antioxidant, corrigent, flavor, colorant, a functionalmaterial such as cyclodextrin and biodegradable polymer, stabilizer. Theadditives may be selected from those described in general referencebooks of pharmaceutics.

[0118] The amount of the 15-keto-prostaglandin compound contained in acomposition may vary depending on the formulation of the composition,and may generally be 0.0001-10.0 wt %, more preferably 0.001-1.0 wt %.

[0119] Examples of solid compositions for oral administration includetablets, troches, sublingual tablets, capsules, pills, powders, granulesand the like. The solid composition may be prepared by mixing one ormore active ingredients with at least one inactive diluents. Thecomposition may further contain additives other than the inactivediluents, for example, a lubricant, a disintegrator and a stabilizer.Tablets and pills may be coated with an enteric or gastroenteric film,if necessary. They may be covered with two or more layers. They may alsobe adsorbed to a sustained release material, or microcapsulated.Additionally, the compositions may be capsulated by means of an easilydegradable material such gelatin. They may be further dissolved in aappropriate solvent such as fatty acid or its mono, di or triglycerideto be a soft capsule. Sublingual tablet may be used in need offast-acting property.

[0120] Examples of liquid compositions for oral administration includeemulsions, solutions, suspensions, syrups and elixirs and the like. Saidcomposition may further contain a conventionally used inactive diluentse.g. purified water or ethyl alcohol. The composition may containadditives other than the inactive diluents such as adjuvant e.g. wettingagents and suspending agents, sweeteners, flavors, fragrance andpreservatives.

[0121] The composition of the present invention may be in the form ofspraying composition which contains one or more active ingredients andmay be prepared according to a known method.

[0122] Example of the injectable compositions of the present inventionfor parenteral administration include sterile aqueous or nonaqueoussolutions, suspensions and emulsions comprising one or more activeingredient. Diluents for the aqueous solution or suspension may include,for example, distilled water for injection, physiological saline andRinger's solution. Non-aqueous diluents for solution and suspension mayinclude, for example, propylene glycol, polyethylene glycol, vegetableoils such as olive oil, alcohols such as ethanol and polysorbate. Thecomposition may further comprise additives such as preservatives,wetting agents, emulsifying agents, dispersing agents and the like. Theymay be sterilized by filtration through, e.g. a bacteria-retainingfilter, compounding with a sterilizer, or by means of gas orradioisotope irradiation sterilization. The injectable composition mayalso be provided as a sterilized powder composition to be dissolved in asterilized solvent for injection before use.

[0123] Another formulation of the composition according to the presentinvention may be rectal or vaginal suppository. Said suppository may beprepared by mixing at least one active compound according to the presentinvention with a suppository base e.g. cacao butter and may optionallybe admixed with a nonionic surfactant having a suitable softeningtemperature to improve absorption.

[0124] The term “treatment” or “treating” used herein includes any meansof control such as prevention, care, relief of the condition,attenuation of the condition and arrest of progression.

[0125] The term “drug-induced constipation” used herein is not limitedto a particular constipation condition so far as the condition is causedby using a drug as its side effect, which also includes secondaryconstipation due to the drug use. Further, constipation caused by anadditive or synergistic effect due to combined drug administration isalso included.

[0126] Drugs which cause drug-induced constipation to be treated by thepresent invention may include, for example, opioids of narcotic drugssuch as morphine (such as morphine hydrocholoride and MS contin) andcodeine (such as codeine phosphate); anticholineric agents such asantiparkinsonism drugs (trihexyphenidyl and levodopa), antidepressants(tricyclic antidepressants such as amoxapine, trimipramine,aminotriptyline, imipramine, clomipramine, dosulepin, nortriptyline andlofepramine, tetracyclic antidepressants such as setiptiline,maprotiline and mianserin) and anti-incontinence agents (such aspropanetheline and oxybutynin); antacids (such as alminium preparation),bone weight increasing agents (such as calcium preparations), diuretic,iron preparations, calcium antagonist, benzodiazepine drugs,phenothiazine drugs (such as chlorpromazine), H₂-blockers, pill,tocopherol. Especially, constipation conditions induced by opioid suchas morphine and codeine, and antidepressants such as tricyclicantidepressants including imipramine are effectively treated 0with thecomposition of the present invention.

[0127] In the present invention, “a subject suffering from drug-inducedconstipation or a subject having a strong possibility of suffering fromit” includes both a subject actually constipating due to theadministration of a drug which causes constipation and a subject havinga strong possibility of constipating due to the administration of adrug, for example, a subject being administered with a drug such as anopioid or an antidepressant, that is known to have a strong possibilityof constipation as a side effect.

[0128] In the present invention, a dosage form may include one activeingredient only or a combination of two or more active ingredients. Whena combination of a plurality of active ingredients are used, theirrespective contents can be suitably increased or decreased inconsideration of their effects and safety.

[0129] The composition of, the present invention can further includeother pharmacologically active ingredients as far as they do notcontradict the purpose of the present invention.

[0130] The further details of the present invention will follow withreference to test examples, which, however, are not intended to limitthe present invention.

EXAMPLE 1

[0131] Antagonism to Morphine-Induced Constipation

[0132] Male ICR mice were fasted overnight in wire-bottomed cages toprevent coprophagia, and 15 mice were used for each group. Morphinehydrochloride (Takeda Chemical Industries, Ltd., Osaka Japan) wasinjected intraperitoneally to animals at 5 mg/kg. Immediately after themorphine-injection, 0.1 mL graphite marker (2:1 mixture of PilotINK-30-B and 10% tragacanth mucilage) and 5 mL/Kg vehicle (physiologicalsaline containing 0.01% polysorbate 80 and 0.5% ethanol) or 1, 10, or100 μg/kg test substance (13,14-dihydro-15-keto-16,16-difluoro-PGE₁) in5 mL/Kg of the vehicle were administered orally. A normal control groupreceived graphite marker and vehicle orally in the above volumes withoutthe morphine-injection. One hundred and fifty minutes after theadministration of graphite marker, animals were sacrificed by cervicaldislocation, and examined the caecum for the presence of graphitemarker. It was judged as a positive response when graphite marker wasfound in the caecum (positive score).

[0133] The number of animals in which graphite marker was found in thecaecum (number of animals with positive scores) and its ratio in eachgroup are shown in Table 1. TABLE 1 Number of animals with Ratio ofpositive animals scores^(a))/ with Number of positive Group animalstested scores Normal (vehicle) 15/15** 100%  Morphine + vehicle 3/15 20% Morphine + test substance  1 μg/kg 9/15* 60%  10 μg/kg 13/15** 87%100 μg/kg 14/15** 93%

[0134] In the normal group, graphite marker was found in the caecum inall the 15 animals (100%).

[0135] In the morphine+vehicle group, graphite marker was found in thecaecum in 3 out of 15 animals (20%). The number of positive animals inthe morphine+vehicle group was significantly decreased as compared withthat of the normal group, which indicated that constipation was inducedby the morphine treatment.

[0136] In the groups received test substance at 1, 10 or 100 μg/kgimmediately after the morphine administration, graphite marker was founddose-dependently in the caecum in 9 (60%), 13 (87%) and 14 (93%) out of15 animals, respectively. The test substance group significantlyantagonized the morphine-induced constipation as compared with control(morphine+vehicle) group.

[0137] Above results demonstrate that the substances of the presentinvention antagonize the opioid-induced constipation even at a low doseof 1 μg/kg.

EXAMPLE 2 (COMPARATIVE EXAMPLE)

[0138] Antagonism to Morphine-Induced Constipation

[0139] The effects of conventional cathartics (sennoside and sodiumpicosulfate) clinically used for the treatment of constipation in thepatients applied with morphine on morphine-induced constipation wereevaluated.

[0140] Sennoside (tablets: Novartis Pharma K.K., Tokyo, Japan) werecrushed with mortar and ground into fine powder, and suspended in 0.5%tragacanth solution to yield proper concentration for the intended doselevel of administration. Sodium picosulfate (liquid: Teijin K.K., Tokyo,Japan) was diluted with physiological saline solution.

[0141] Dosage levels of each test substance were set at 1 and 10 timesof clinical daily dosage (clinical daily dosage: sennoside 24 mg, sodiumpicosulfate 7.5 mg; assuming body weight is 50 kg, they are equivalentto 0.48 mg/kg and 0.15 mg/kg, respectively). Each diluent for testsubstance was used as a vehicle.

[0142] The experimental procedure was the same as described in example1.

[0143] The number of animals in which graphite marker was found in thecaecum (number of animals with positive scores) and its ratio in eachgroup are shown in Table 2 (sennoside) and Table 3 (sodium picosulfate).TABLE 2 Number of animals with Ratio of positive animals scores^(a))/with Number of positive Group animals tested scores Normal (vehicle) 10/10** 100%  Morphine + vehicle 2/10 20% Morphine + sennoside 0.48mg/kg 2/10 20%  4.8 mg/kg 2/10 20%

[0144] TABLE 3 Number of animals with Ratio of positive animalsscores^(a))/ with Number of positive Group animals tested scores Normal(vehicle)  8/10* 80% Morphine + vehicle 3/10 30% Morphine + sodiumpicosulfate 0.15 mg/kg 3/10 30%  1.5 mg/kg 4/10 40%

[0145] The cathartics (sennoside and sodium picosulfate) conventionallyused for the treatment of constipation in patients applied with morphinehad no effect on morphine-induced constipation at the clinical dailydosage and even at 10 times of the clinical daily dosage.

[0146] Above results demonstrate that conventional cathartics, whichhave purgative action, does not necessarily antagonize opioid-inducedconstipation, and suggests that the conventional cathartics are hard tocontrol constipation sufficiently.

EXAMPLE 3

[0147] Effect on Analgesic Action

[0148] Male ICR mice were fasted overnight in wire-bottomed cages toprevent coprophagia. The tail of the animal was pinched with clampforceps, and the response time from the tail-pinch to fierce striking,biting or crying was measured. 18 mice whose response time of 2 secondor shorter were used as test animals. Morphine hydrochloride (TakedaChemical Industries, Ltd., Osaka, Japan) was injected intraperitoneallyto the animals at 5 mg/kg. Immediately after the morphine-injection,vehicle (physiological saline containing 0.01% polysorbate 80 and 0.5%ethanol) or 1, 10, or 100 μg/kg test substance(13,14-dihydro-15-keto-16,16-difluoro-PGE₁) dissolved in the vehicle wasadministered orally in an administration volume of 5 mL/kg. The animalsof normal control group received vehicle orally in the above volumewithout morphine-injection.

[0149] The response time of each animal following tail-pinch wasmeasured 30, 60, 90, 120 and 150 minutes after the administration. If amouse took longer than 10 seconds to respond, measurement was stopped toavoid injuring the tail tissue, and the response time was recorded as 10second. Results are shown in Table 4. TABLE 4 Number Response time, mean± S.E., sec. of Before Time after administration Group animalsadministration 30 min 60 min 90 min 120 min 150 min Normal (vehicle) 180.9 ± 0.1 1.0 ± 0.1  1.1 ± 0.1  1.1 ± 0.1  1.1 ± 0.1 1.3 ± 0.1Morphine + vehicle 18 1.0 ± 0.1 2.8 ± 0.6** 1.9 ± 0.3* 1.8 ± 0.4⁺ 1.4 ±0.2 1.2 ± 0.1 Morphine + test substance  1 μg/kg 18 1.0 ± 0.1 3.2 ±0.7** 2.3 ± 0.6⁺ 1.5 ± 0.2* 1.3 ± 0.1 1.3 ± 0.1  10 μg/kg 18 1.0 ± 0.13.4 ± 0.5**  1.8 ± 0.2** 1.4 ± 0.1* 1.3 ± 0.1 1.2 ± 0.1 100 μg/kg 18 1.0± 0.1 2.9 ± 0.6** 1.8 ± 0.3* 1.5 ± 0.1* 1.2 ± 0.1 1.3 ± 0.1

[0150] The response times before the administration were about 1 secondin all the groups, and no difference was found among the groups.

[0151] In the normal group, the response time at every measurement timeafter the vehicle administration was not different from that of beforethe administration.

[0152] In the morphine+vehicle group, a significant increase in theresponse time was found 30 and 60 minutes after the morphine-treatmentas compared with that of the normal group. The tendency for the increaseof the response time was still found 90 minutes after themorphine-treatment. The analgesic effect of morphine was almostcompletely disappeared 120 and 150 minutes after the morphine-treatment.

[0153] In each morphine+test substance group, significant increase ofresponse time was observed as compared with that of the normal group. Inthe morphine+test substance groups, the response times were similar tothose observed in the morphine+vehicle group.

[0154] No significant difference in the response time was found betweenthe morphine+vehicle group and the morphine+test substance groups, whichindicates that test substance did not affect the analgesic action ofmorphine.

[0155] Above results demonstrates that the substances of the presentinvention does not affect the analgesic action of opioid even at a highdose of 100 μg/kg.

EXAMPLE 4

[0156] Antagonism to Imipramine (a Tricyclic Antidepressant)-InducedConstipation

[0157] Male ICR mice were fasted overnight in wire-bottomed cages toprevent coprophagia, and 10 mice were used for each group. Imipraminehydrochloride (Wako Pure Chemical Industries, Ltd., Osaka, Japan) at 60mg/kg was injected intraperitoneally to the animals. Immediately afterthe imipramine-injection, 0.1 mL of carbon marker (10% carbon powdersuspension in 5% gum Arabic) and vehicle (physiological saline solutioncontaining 0.01% polysorbate 80 and 0.5% ethanol) or test substance(13,14-dihydro-15-keto-16,16-difluoro-PGE₁) in an administration volumeof 5 mL/kg were orally administered. A normal control group receivedcarbon marker and vehicle in the above volume orally without theimipramine-injection. One hundred and fifty minutes after theadministration of carbon marker, animals were sacrificed by cervicaldislocation, and examined the caecum for the presence of carbon marker.It was judged as a positive response when carbon marker was found in thecaecum (positive scores).

[0158] The number of animals in which carbon marker was found in thecaecum (number of animals with positive scores) and its ratio in eachgroup are shown in Table 5.

[0159] These results demonstrate that the substance of the presentinvention antagonize the imipramine-induced constipation. TABLE 5 Numberof animals with Ratio of positive animals scores^(a))/ with Number ofpositive Group animals tested scores Normal (vehicle) 9/10** 90%Imipramine + vehicle 1/10  10% Imipramine + 3/10  30% test substance 10μg/kg Imipramine + 7/10** 70% test substance 100 μg/kg

EXAMPLE 5 (COMPARATIVE EXAMPLE)

[0160] Antagonism to Imipramine (a Tricyclic Antidepressant)-InducedConstipation

[0161] The effect to the imipramine-induced constipation was evaluatedon the cathartic (sennoside) clinically used for the treatment of theconstipation in patients. Preparation and dose levels of sennoside werethe same as described in example 2. The experimental procedure was thesame as described in example 4.

[0162] The number of animals in which carbon marker was found in thecaecum (number of animals with positive scores) and its ratio in eachgroup are shown in Table 6.

[0163] These results demonstrate that sennoside has no effect on theimipramine-induced constipation. TABLE 6 Number of animals with Ratio ofpositive animals scores^(a))/ with Number of positive Group animalstested scores Normal (vehicle)  7/10** 70% Imipramine + vehicle 1/10 10%Imipramine + 2/10 20% sennoside 0.48 μg/kg Imipramine + 2/10 20%sennoside 4.8 μg/kg

What is claimed is:
 1. A method for treating drug-induced constipationcomprising a step of administering an effective amount of a15-keto-prostaglaindin compound to a subject suffering from drug-inducedconstipation or a subject having a strong possibility of suffering fromit.
 2. The method of claim 1, wherein a 15-keto-prostaglaindin compoundis the one represented by the general formula (I):

wherein L, M and N are hydrogen, hydroxy, halogen, lower alkyl,hydroxy(lower)alkyl or oxo, wherein at least one of L and M is a groupother than hydrogen, and the five-membered ring may have at least onedouble bond; A is —CH₂OH, —COCH₂OH, —COOH or a functional derivativethereof; B is —CH₂—CH₂—, —CH═CH— or —C≡C—; R₁ is a saturated orunsaturated bivalent lower or medium aliphatic hydrocarbon residue,which is unsubstituted or substituted with halogen, alkyl, hydroxy, oxo,aryl or heterocyclic group and at least one of carbon atom in thealiphatic hydrocarbon is optionally substituted by oxygen, nitrogen orsulfur; and Ra is a saturated or unsaturated lower or medium aliphatichydrocarbon residue, which is unsubstituted or substituted with halogen,oxo, hydroxy, lower alkoxy, lower alkanoyloxy, cyclo(lower)alkyl,cyclo(lower)alkyloxy, aryl, aryloxy, heterocyclic group orhetrocyclic-oxy group; cyclo(lower)alkyl; cyclo(lower)alkyloxy; aryl;aryloxy; heterocyclic group; heterocyclic-oxy group.
 3. The method ofclaim 1, wherein the 15-keto-prostaglandin compound is a13,14-dihydro-15-keto-prostaglandin compound.
 4. The method of claim 1,wherein the 15-keto-prostaglaindin compound is a 15-keto-16-mono- ordi-halogen-prostaglaindin compound.
 5. The method of claim 1, whereinthe 15-keto-prostaglaindin compound is a 13,14-dihydro-15-keto-16-mono-or di-halogen-prostaglaindin compound.
 6. The method of claim 1, whereinthe 15-keto-prostaglaindin compound is a 15-keto-16-mono- ordi-fluoro-prostaglaindin compound.
 7. The method of claim 1, wherein the15-keto-prostaglandin compound is a 13,14-dihydro-15-keto-16-mono- ordi-fluoro-prostaglaindin compound.
 8. The method of claim 1, wherein the15-keto-prostaglaindin compound is a 15-keto-prostaglandin E compound.9. The method of claim 1, wherein the 15-keto-prostaglandin compound is13,14-dihydro-15-keto-16,16-difluoro-prostaglandin E₁.
 10. The method ofclaim 1, wherein the drug inducing constipation is an opioid compound.11. The method of claim 10, wherein the opioid compound is a morphinecompound or a codeine compound.
 12. The method of claim 1, wherein thedrug inducing constipation is an anticholinergic drug.
 13. The method ofclaim 12, wherein the anticholinergic drug is a tricyclicantidepressant.